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At SB Dental Solutions, we help our clients understand and accomplish all aspects of the dental billing process. Perhaps the most complicated piece of the dental billing puzzle comes from dental insurance contracts. These contracts are legally binding documents that often differ from plan to plan and usually contain complex jargon and legalese. Dental practices must comply with the contract to the letter, but unfortunately, many don’t fully understand the requirements of their provider contract. Take these three common contract conflicts, for example:
Billing Patients Your Standard Fees, Not Contracted Fees One of the fundamental terms of most insurance contracts stipulates that the provider must accept the insurance company’s fees. Discounted fees constitute a major portion of the insured patient’s benefit. The dentist may only charge for the allowed copay or percentage. Any difference between the dentist’s standard fee and the allowable amount must be written off, as stipulated by the insurance agreement. Skipping the Insurance Altogether A contracted provider must, by law, bill the patient’s insurance. Patients generally benefit from this, even for noncovered services, because (as detailed above) insurance plans provide discounted fees. Furthermore, a carrier’s contract with the insured entitles patients to specific benefits and obligates the insurance company to provide those benefits. Failure to submit correct claims prevents the carrier from upholding their legal responsibility to your patient. And finally, practices need to code thoroughly to ensure that the patient’s records (both the ones kept by their dental provider and by their insurance carrier) accurately reflect treatment rendered. If providers fail to bill for services, they have committed fraud and can be prosecuted. Charging Patients for Down-Coded Procedures Down-coding (or remapping) occurs when the insurance plan covers a lower-cost alternative procedure, rather than the procedure the provider billed. If their contract includes a LEAT (or Least Expensive Alternative Treatment) clause, then they are within their rights to down code. For example, many insurance companies cover white (composite) fillings at the rate of cheaper metallic (amalgam) fillings. Simply put, they do this because they can, and it saves money. Some (but not all) insurance plans have clauses that specifically prohibit billing patients the difference for down-coded procedures. We help our clients navigate these concerns and more with our comprehensive billing solution. Give us a call to learn more.
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At SB Dental Solutions, our expert staff consistently helps clients reach new levels of productivity and success. We take pride in delivering a range of dental billing benefits, including the following:
1. More Accurate Billing Dental billing can be complex and time-consuming, often reducing practice efficiency when staff members have to spend valuable time correcting errors. Navigating the intricacies of various insurance companies and hundreds of dental codes can overwhelm even the most experienced professionals. Plus, dental billing regulations continue to grow more complicated every year. From submitting claims to estimating patient portions, our specialized dental billing professionals bring precision and efficiency to every step, ensuring a more accurate process. 2. Preventing Burnout Burnout is a significant challenge for thriving dental practices. When overwhelmed by billing tasks, team members are more prone to mistakes, which can result in lost revenue and high staff turnover. At SB Dental Solutions, we alleviate the burden of dental billing, allowing your team to focus on what matters most: patient care. By improving billing accuracy and reducing administrative strain, we help protect your practice from the costly effects of burnout. 3. Streamlined Cashflow Inefficient billing practices can lead to cashflow bottlenecks that strain a business. Our team at SB Dental Solutions employs robust billing administration strategies, leading to faster, more efficient processes than in-house billing can often provide. With increased claim accuracy, timely denial escalations, improved patient portion estimates, and a smoother reimbursement process, outsourcing your billing gives your practice greater control over its financial success. 4. Simplifying Insurance Billing Many dental professionals assume that medical insurance rarely covers dental procedures. However, health insurance plans increasingly cover dental, surgical, and endodontic treatments. With medical insurance now encompassing more dental services than ever, there’s never been a better time to explore this profitable, patient-friendly option. At SB Dental Solutions, we simplify the process of integrating medical insurance billing into your practice with minimal effort required from your staff. Ready to optimize your dental billing process? Contact us today to learn how we can help. |
AuthorSB Dental Solution Archives
October 2024
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